Refractory status epilepticus in dogs: ketamine and propofol
7-year-old crossbreed dog in status epilepticus for 40 minutes. It has received two IV midazolam boluses and an IV levetiracetam load. Glucose, calcium and electrolytes are normal. Seizure activity continues.
What is the most appropriate next step and why?
chevron_right Show answer and explanation
A. Keep giving diazepam boluses until it stops
In prolonged status GABA-A receptors are internalised and benzodiazepines lose efficacy; repeating them only adds respiratory and cardiovascular depression.
B. Rectal potassium bromide loading
Bromide takes too long to reach effective levels and given rectally it can cause diarrhoea; it is not an emergency drug.
C. Constant rate infusion of propofol or ketamine, with airway protection and monitoring
Correct. Ketamine blocks NMDA receptors, which increase in prolonged status, and propofol also acts through other pathways. Maintain for some hours and wean gradually.
D. IV dexamethasone for cerebral oedema
Corticosteroids do not stop seizures and, in an undiagnosed dog, may interfere with the work-up (e.g. lymphoma or meningoencephalitis). They do not replace control of the electrical activity.
lightbulb Key takeaway
In refractory status the priority is to stop seizure activity while protecting the airway, oxygenation, temperature and blood glucose. As status persists, GABAergic drugs lose efficacy and NMDA antagonists such as ketamine become relevant.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.